Healthcare Technology:When you got
started, what features and functions did
users, especially in hospital settings, look
for in scheduling systems? What were
the main business problems they were
trying to solve?

Michael Meisel: During the 1980s, hospitals
– nursing departments in particular –
were just beginning to assess how computers
might help them effectively schedule
their staff. In fact, until the middle of
that decade, less than 200 hospital-based
employee scheduling systems were
installed in the entire U.S. Then, when the
severe nursing shortage of the late 1980s
reached crisis proportions, hospitals frantically
scrambled for solutions to reduce the
resources required to provide adequate
staffing for their units. Back then, nurse
managers were looking for the basics – the
ability to create a schedule to meet core
staffing requirements and to evenly distribute
staffing coverage across the week
and for all shifts. Of course, they also wanted
to reduce the amount of time spent
managing the scheduling process itself.

HCT:How have users’ demands changed?

MM: They still want to achieve balanced
schedules that meet basic staffing needs,
but now coverage is not the only issue. To
meet demands to more effectively manage
resources – and to cope with budget constraints
– cost has become a much more
important component of the scheduling
process, along with skill competencies
and workload balancing.

MM: Yes. Users demand that systems provide
the tools to predict staffing needs
and adjust for skill-level mix and associated
costs as patient volume and workloads
change. They have to be able to cost out
scheduling and staffing decisions in real
time as well as forecast staffing needs and
costs for future budgeting.

HCT:Can you elaborate on some of the
latest trends in hospital staffing?

MM: Certainly. The concept of shift bidding
has received a lot of attention lately. The
idea, initially, began as a pure reverse auction
concept. That is, employees would bid
against each other, reducing the shift price
down until the lowest bid won. But it has
since evolved into a workforce communication
tool. It’s not all about who will pick up
the shift for the lowest hourly rate, but
rather it provides employees with up-to-theminute
information on what shifts are available
and where the greatest need is. Some
organizations still promote bidding, but now
it is more about offering positive incentives
for employees to work shifts most in need of
staffing, as opposed to pitting them against
one another to get the lowest hourly rate.

HCT: You mentioned the nursing shortage
of the late 1980s. Aren’t we in a nursing
shortage today?

MM: The current nursing shortage has
troubled the nation’s healthcare system
since 1998. Some research on the nursing
labor market in the U.S. suggests that this
long-running shortage may be moderating,
in part because of significant increases
in prevailing levels for wages paid to
registered nurses.Whether the shortage is
diminishing or not, the reality on the front lines of hospital administration is that
recruiting, hiring, training and retaining
nurses continue to present difficult challenges
to hospitals across the country.

HCT:Is self-scheduling a response to
today’s nursing shortage?

MM: Interesting that you mention that. Selfscheduling
has been around for decades.
Our RES-Q software has supported the concept
for years. Now that newer technologies
enable employees to connect to their scheduling
system via the Internet, self-scheduling
has taken on a whole new dimension.
Employees can now enter their work requests
remotely.Managers can view these
requests and approve them online. Scheduling
rules help to manage the self-scheduling
process so managers can complete a
schedule in minutes, not hours. The concept
is designed to empower employees to work
with their peers when creating their schedules.
In the 1990s it was called “self-governance.”
I prefer calling it "adults fly free.”
Not only does this collaborative effort
build trust with and among staff, it enhances
staff retention and satisfaction.We
have taken the approach of integrating selfscheduling
with online shift requesting so
that an employee can not only make their
future schedule requests, but they can view
their current schedule against the needs of
the hospital and remotely request to pick up
extra shifts to fill any existing staffing shortages.
They can also work out shift swaps
with employees in their department.

MM: Accreditation requirements certainly
have. According to the Joint Commission on
Accreditation of Healthcare Organizations
[JCAHO], you have to have current competency
assessments for all staff. Thus, in
resource management and scheduling systems
today, we have to integrate information
on employee competencies and credentials,
as well as automate tracking of
information on employees’ continuing education.
Systems have to be able to show
users whether various staffing scenarios
are not only cost-effective but also whether
they meet JCAHO standards. This has
evolved into an entirely new feature set
integrated within resource management
and scheduling solutions.

HCT:Have decision support and reporting
requirements become more important?

MM: Absolutely. Again, years ago, the basic
requirement of resource management systems
was to produce balanced staffing
schedules. Today, data analysis and reporting,
both in real time as well as for retrospective
and prospective analysis, are critical
requirements. Healthcare organizations
now use resource management and scheduling
systems to decrease overtime,minimize
the use of expensive outside staffing
resources and maximize the use of intrastaff
and cross-facility floating. Decision
support features in scheduling systems help
users effectively manage labor resources
and reduce costs enterprisewide.

HCT:Can you cite examples of such cost
savings?

MM: Many of our clients have achieved
real dollar savings through productivity
gains and time savings. Improving staff
allocation reduces overtime and outside
agency costs, often resulting in thousands
of dollars in savings each month. In addition,
the automation provided by resource
scheduling applications typically saves in
excess of 200 hours per pay period by
reducing the amount of time spent in
manual schedule preparation and modification,
time card verification and staff
certification compliance.

HCT:What are typically the biggest hurdles
in implementing scheduling systems?

MM: As with any system of this magnitude,
there are now so many features available to
the user that many systems are often underutilized.
I call this the “word processor syndrome.”
While most of us use word processing
applications to type letters and so forth,
how many of us truly utilize all of the available
features such as desktop publishing
and mail-merge? The bottom line is that a
well-defined project plan and progressive
education and training are the key factors in
successfully implementing a scheduling system.
Ongoing training and system reviews
are also critical to ensure that users are getting
the maximum benefit from these comprehensive
resource management tools.

HCT:What are your customers saying
about the future direction of resource
management and scheduling systems?

MM: They are asking for systems that
provide tools to make informed scheduling
decisions by predicatively showing
them both the clinical and financial
impact of decisions in an environment
shaped by constantly shifting resource
demands as well as ever-increasing
organizational size and complexity.
Additionally, customers are demanding
integration with other healthcare information
system applications. For example,
interfacing to time-and-attendance systems
is essential for cost analysis and
budgeting, and many hospitals interface
scheduling to their human resource management
systems. That eliminates duplicate
data entry of employee demographic
information. So, this is a big part of what
we do in every implementation.